APPENDIX

The Clinic will use reasonable means to protect the security and confidentiality of information sent and received using the Services ("Services" is defined in the accompanying consent form to use electronic communications). However, because of the risks outlined below, the Clinic cannot guarantee the security and confidentiality of electronic communications:

• Use of electronic communications to discuss sensitive information can increase the risk of such information being disclosed to third parties.
• Despite reasonable efforts to protect the privacy and security of electronic communication, it is not possible to completely secure the information.
• Employers and online services may have a legal right to inspect and keep electronic communications that pass through their system.
• Electronic communications can introduce malware into a computer system, and potentially damage or disrupt the computer, networks, and security settings.
• Electronic communications can be forwarded, intercepted, circulated, stored, or even changed without the knowledge or permission of the Clinic or the patient.
• Even after the sender and recipient have deleted copies of electronic communications, back-up copies may exist on a computer system.
• Electronic communications may be disclosed in accordance with a duty to report or a court order.
• Videoconferencing using services such as Skype or FaceTime may be more open to interception than other forms of videoconferencing.

If a non-secure email or text is used as an e-communication tool, the following are additional risks:

• Email, text messages, and instant messages can more easily be misdirected, resulting in increased risk of being received by unintended and unknown recipients.
• Email, text messages, and instant messages can be easier to falsify than handwritten or signed hard copies. It is not feasible to verify the true identity of the sender, or to ensure that only the recipient can read the message once it has been sent.

Conditions of using the Services

• While the Clinic will attempt to review and respond in a timely fashion to your electronic communication, the Clinic cannot guarantee that all electronic communications will be reviewed and responded to within any specific period of time. The Services will not be used for medical emergencies or other time-sensitive matters.
• If your electronic communication requires or invites a response from the Clinic and you have not received a response within a reasonable time period, it is your responsibility to follow up to determine whether the intended recipient received the electronic communication and when the recipient will respond.
• Electronic communication is not an appropriate substitute for in-person or over-the-telephone communication or clinical examinations, where appropriate, or for attending the Emergency Department when needed. You are responsible for following up on the Clinic's electronic communication and for scheduling appointments where warranted.
• Electronic communications concerning diagnosis or treatment may be printed or transcribed in full and made part of your medical record. Other individuals authorized to access the medical record, such as staff and billing personnel, may have access to those communications.
  • The Clinic may forward electronic communications to staff and those involved in the delivery and administration of your care. The Clinic might use one or more of the Services to communicate with those involved in your care.
  • If the Clinic refers you to a specialist or other care provider, your consent to the referral includes your implied consent to the transmission of clinical information about you.
  • You agree to inform the Clinic of any types of information you do not want sent via the Services.
  • The Clinic is not responsible for information loss due to technical failures associated with your software or internet service provider.

Instructions for communication using the Services
To communicate using the Services, you must:

• Reasonably limit or avoid using an employer's or other third party's computer.
• Inform the Clinic of any changes in the patient's email address, mobile phone number, or other account information necessary to communicate via the Services.

If the Services include email, instant messaging and/or text messaging, the following applies:

• Include in the message's subject line an appropriate description of the nature of the communication (e.g. "Prescription renewal"), and your full name in the body of the message.
• Review all electronic communications to ensure they are clear and that all relevant information is provided before sending to the Clinic.
• Take precautions to preserve the confidentiality of electronic communications, such as using screen savers and safeguarding computer passwords.
• Withdraw consent only by secure email or written communication to the Clinic.
• If you require immediate assistance, or if your condition appears serious or rapidly worsens, you should not rely on the Services. Rather, you should call the Clinic's office or take other measures as appropriate, such as going to the nearest Emergency Department or urgent care clinic.